Provider Demographics
NPI:1265639504
Name:TARR, STEPHEN JAY (RT, RPA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JAY
Last Name:TARR
Suffix:
Gender:M
Credentials:RT, RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 BRIDGEPORT DR
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-4401
Mailing Address - Country:US
Mailing Address - Phone:706-968-7789
Mailing Address - Fax:
Practice Address - Street 1:5016 US HWY 75
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4584
Practice Address - Country:US
Practice Address - Phone:678-904-6820
Practice Address - Fax:678-904-6824
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL05 IL1144243U00000X
IL3266862471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography